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New Way To View Prostate Cancer That Has Spread To The Bones
The technique combines MRI with diffusion-weighted imaging
A new imaging technique could allow doctors to accurately assess if cancer has spread into the bones of prostate cancer patients, and how severe it is.
The new technique combines a whole-body MRI scan with diffusion-weighted imaging, which can distinguish tumours from other tissues based on their structure. The resulting images provide a clear picture of how far cancer has spread in the bones and can help to predict how long patients will survive.
Prostate cancer is the second most common cancer among men and spreads to other parts of the body – predominantly to the bone – in more than 84% of patients, greatly reducing survival rates.
(From left to right) Volume of metastatic bone disease estimated on whole-body MRI with diffusion-weighted imaging and overall survival: vol = 0.03L, >39.5 months; vol = 0.68L, 10.0 months; vol = 1.62L, 5.2 months (photo: Nina Tunariu).
Cancer that spreads to other parts of the body is known as metastatic cancer. Conventional imaging techniques – including imaging that uses computed tomography, bone scintigraphy and radioactive markers – have failed to show the true extent of bone metastases in prostate cancer patients.
Results using this new technique, published in the prestigious journal Radiology, suggest that whole-body MRI with diffusion-weighted imaging (WBDWI) could provide a new, non-invasive way of monitoring the spread of cancer in the bones and how it is responding to treatment.
Researchers tested the new technique on 43 patients with advanced prostate cancer and it compared favourably with existing measures of disease severity, such as blood tests for circulating tumour cells and measuring haemoglobin levels. These results have the potential to help doctors choose appropriate treatments for patients based on how advanced their disease is.
The findings were a result of collaboration between imaging and prostate cancer experts at The Institute of Cancer Research, London, and The Royal Marsden, including Professor Martin Leach, Dr Nina Tunariu, Dr Raquel Perez-Lopez, Professor Dow-Mu Koh and Professor Johann de Bono.
Facts About Prostate Cancer
Understanding Prostate CancerProstate cancer is the most common cancer after skin cancer in men in the United States.
In some men, it is slow growing and unlikely to cause serious problems. In others, the disease is very aggressive. If it's detected early, prostate cancer is highly treatable, and most men survive.
Fred Hutchinson Cancer Center offers comprehensive prostate cancer treatment from a team of experts.
What Is Prostate Cancer?Prostate cancer starts in the prostate, a gland located below the bladder and in front of the rectum.
Many physicians used to consider prostate cancer in older men to be just part of the normal aging process, and the disease was largely ignored, except when it struck younger men. Now there are newer, better treatments for prostate cancer, and many men who have or had prostate cancer at any age are leading active, productive lives.
Understanding Your ProstateYour prostate makes and stores seminal fluid — a milky liquid that protects and nourishes sperm. Your prostate surrounds part of your urethra, the tube that carries urine and semen out of your body.
Many men develop a noncancerous condition called benign prostatic hyperplasia (BPH), or enlargement of the prostate. If the prostate, which is normally about the size of a walnut, grows too large, it can slow or block the flow of urine.
Most prostate cancer develops in the zone of the prostate near the rectum (peripheral zone), which is why a digital rectal exam is a useful screening test.
Prostate cancer is complex. There are a lot of things to think about before you and your physician choose a treatment plan. First, know that if it's detected early, prostate cancer is highly treatable, and most men with prostate cancer survive. Our specialists at Fred Hutch are here to help you.
PSA TestThe PSA test has come under fire because of concerns that it has led to over diagnosis and overtreatment. In 2013, the American Urological Association released new PSA screening guidelines for men based on their age, health, and risk profile.
SymptomsProstate cancer symptoms typically don't appear early in the disease. In many men, physicians first detect signs of prostate cancer during a routine check-up.
More advanced prostate cancer symptoms may include:
Many of these symptoms are also seen with noncancerous diseases. They may be similar to BPH symptoms or prostatitis symptoms. (Prostatitis is infection of the prostate.) If you are experiencing any signs and symptoms of prostate cancer, call your doctor.
DiagnosingWhen it is diagnosed early, prostate cancer is curable. Good prostate cancer screening tests, like the prostate-specific antigen (PSA) test, have resulted in early diagnosis in about 80 percent of men with the disease. According to the American Cancer Society, all of these men survive at least five years.
Whether cancer is suspected based on symptoms or a digital rectal exam or PSA test, the actual diagnosis is made with a prostate biopsy, a procedure in which samples of your prostate are removed and examined under a microscope.
A core needle biopsy, the main method for diagnosing prostate cancer, is typically performed in a physician's office by a urologist.
Your biopsy samples will be sent to a lab to be examined by a pathologist. Getting results usually takes a few days.
Fred Hutch offers an imaging test called prostate-specific membrane antigen (PSMA) positron emission tomography (PET), which is considered the most sensitive measure of prostate cancer detection. This test may be appropriate in certain situations. We also have an imaging test called Axumin® PET. Before the scan, you get an injection of fluciclovine F 18 (Axumin®), a radioactive agent that tends to collect in areas with cancer activity, which then light up on your scan.
Staging: The TNM SystemStaging is done as part of the diagnosis process to determine how extensive your cancer is within your prostate and whether it has spread to lymph nodes or other organs.
Prostate cancer is typically staged using the TNM system, which is based on:
Using this information, prostate cancer is then grouped into stages I through IV, with stage I being the least advanced and stage IV being the most advanced.
Stage I: Cancer is confined to your prostate. Gleason score is 6 or below. PSA level is less than 10.Stage II: The tumor is more advanced but does not extend beyond your prostate.Stage III: The tumor extends beyond your prostate and may be in a seminal vesicle. Cancer has not spread to lymph nodes.Stage IV: The tumor has spread to another part of your body, such as your bladder, rectum, lymph nodes or bones.
Testing for Prostate Cancer MetastasisAfter your biopsy, additional tests or imaging may be performed to check for cancer spread, though these are not required in all men with newly diagnosed prostate cancer.
Many centers, including Fred Hutch, are testing other means of finding cancer spread using new types of positron emission tomography (PET) scans. We offer prostate-specific membrane antigen (PSMA) PET, which is considered the most sensitive measure of prostate cancer detection. We also have an imaging test called Axumin® PET. Sometimes lymph nodes around the prostate may be checked for metastasis in order to design treatment appropriately.
At Fred Hutch and UW Medicine, a long-term effort has identified cells in the bone marrow that originated from prostate cancer, even in the absence of other evidence of spread. With these and other studies being offered to men with advanced prostate cancer, we hope to find ways to identify men at the highest risk of relapse so this knowledge can inform our treatment recommendations.
What Causes Prostate Cancer?While the exact cause of prostate cancer is unknown, generally speaking it results from mutations in cell DNA.
Each year about 160,000 men are diagnosed with prostate cancer in the U.S. And about 27,000 die of the disease. Prostate cancer is the third leading cause of cancer death, behind lung cancer and colon cancer, in men in the United States.
The incidence of prostate cancer has nearly doubled over the past 20 years. One possible reason is that, due to a decline in deaths from heart disease, more men are living longer, reaching ages at which the risk of prostate cancer is highest.
Fred Hutch has researched and treated for Prostate Cancer for decades. ResourcesThere are many resources online for learning about your disease. Health educators at the Fred Hutch Patient and Family Resource Center have compiled a list of trusted sources to help you get started.
Whether you are newly diagnosed, going through treatment or know someone with cancer, our staff are available to tailor personalized resources and answer questions about support options in the community.
Cancer Research OrganizationsOur list of online resources provides accurate health information from reliable and reputable sources, like the National Cancer Institute (NCI), the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN).
Cancer Support OrganizationsOur list includes local and national organizations that are dedicated to improving the quality of life for patients and family members through providing emotional support, education and community.
Strong Link Between Bone Biomarkers And Prostate Cancer Survival
Prostate cancer is the second leading cause of death in American men. Understanding the factors that influence patient outcomes is critical for improving treatment and survival rates.
Research led by UC Davis Comprehensive Cancer Center reveals a link between bone metabolism biomarkers and survival in men with newly diagnosed hormone-sensitive prostate cancer (HSPC) who received androgen deprivation therapy (ADT). The work was published in European Urology.
The study analyzed results from a SWOG Cancer Research Network Phase 3 trial of nearly 1,000 patients on ADT, including some who were also on the novel hormonal therapy Orteronel. Patients participating in the trial came from 248 academic and community centers throughout the country.
Bone biomarkers for both bone loss and bone formation were measured in HSPC patients enrolled in the trial.
The researchers found that elevated bone biomarkers were associated with an increased risk of death. Bone biomarkers have been found to influence overall survival in men with castration-resistant prostate cancer (CRPC), but have not been fully established for HSPC. CRPC is a prostate cancer that continues to grow even when testosterone levels are greatly reduced.
"Our findings show that high levels of bone turnover biomarkers are associated with a shorter lifespan in men newly diagnosed with metastatic HSPC," said UC Davis Comprehensive Cancer Center Director Primo "Lucky" Lara Jr. "In the future, knowing one's bone biomarker status could improve how we predict patient outcomes and enhance treatment considerations for men with HSPC."
A finely balanced interaction between cells that rebuild bone and cells that destroy bone is common in men with advanced prostate cancer. These men often present with skeletal metastasis, a common source of bone pain and fracture that can affect their survival.
In addition, men with metastatic HSPC are typically treated with ADT, which disrupts bone turnover and contributes to the development of bone diseases such as osteopenia and osteoporosis. Previous studies have shown that elevated levels of blood-based biomarkers of bone turnover predict survival in men with CRPC and bone targeted therapy may help patients with highly elevated markers.
"This study takes a similar look at bone turnover biomarkers in men with advanced or metastatic HSPC who are initiating ADT as part of a large phase 3 clinical trial," said co-author and UC Davis Comprehensive Cancer Center clinical scientist Mamta Parikh. She is also the cancer center's director of genitourinary malignancies. "Ultimately, our findings add to the growing understanding of the complex interplay between cancer and bone metabolism, which will also help us design of future clinical trials."
More information: Primo N. Lara Jr et al, Bone Biomarkers and Subsequent Survival in Men with Hormone-sensitive Prostate Cancer: Results from the SWOG S1216 Phase 3 Trial of Androgen Deprivation Therapy with or Without Orteronel, European Urology (2023). DOI: 10.1016/j.Eururo.2023.03.036
Citation: Strong link between bone biomarkers and prostate cancer survival (2023, May 8) retrieved 30 May 2023 from https://medicalxpress.Com/news/2023-05-strong-link-bone-biomarkers-prostate.Html
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